# FUNCTION FIRST PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114430071
- **Authorized official:** DR. GREGORY KYLE KINTZING DPT (CEO)
- **Authorized official phone:** (318) 828-1450

## Contact information

- **Practice address:** 7607 FERN AVE STE 704, SHREVEPORT, LA 71105-5744
- **Practice address phone:** (318) 828-1450
- **Practice address fax:** (318) 828-2697
- **Mailing address:** 7607 FERN AVE STE 704, SHREVEPORT, LA 71105-5744
- **Mailing address phone:** (318) 828-1450
- **Mailing address fax:** (318) 828-1450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 08117 | LA | — |
| 2251G0304X | Geriatric Physical Therapist | 08117 | LA | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 11/13/2017
- **Last updated:** 07/15/2020